Dr. Suprakash Chaudhury
Department of Psychiatry, Dr D.Y. Patil Medical College, India.


ISBN 978-93-89816-86-0 (Print)
ISBN 978-93-89816-87-7 (eBook)
DOI: 10.9734/bpi/rtcms/v1


This book covers all areas of medical sciences. The contributions by the authors include eyelid; chondral graft; skin tumor; reconstruction surgery; women’s health; lymphoepithelioma; prostate gland carcinoma; diagnostic features; urinary bladder; adenocarcinoma; urethra; genital tract; extrarenal retroperitoneal angiomyolipoma; hamartomas; tumours; melanoma; genitourinary tract; ischemia modified albumin; pregnancy; pre-eclampsia; hypertension; normal pregnancy; restrictive cardiomyopathy; heart failure; infiltrative cardiomyopathies; cardiac imaging; transurethral resection of prostate; bleeding; hematuria; diabetes mellitus etc. This book contains various materials suitable for students, researchers and academicians in the field of medical sciences.



The Use of Ear Tissue in the Reconstruction of Eyelids in Patients with Excised Neoplastic Lesions

Marco Zeppieri, Pier Camillo Parodi

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 1-9

Purpose: To assess surgical outcomes of lower lid reconstruction surgery using auricular conchal tissue.

Methods: This prospective study included 20 patients that underwent reconstructive lower lid surgery using autologous auricle chondral-perichondral graft tissue. Auricle tissue was used to provide adequate support and protection with similar conjunctiva tarsal structures on overlying soft tissues in patients with pathologic inferior lid tissue loss requiring reconstructive surgery. Biopsies with histopathology and cytology analysis were taken after 1 year. Cytology analysis using CK 19 was used to confirm newly formed conjunctiva overlying the graft.

Results: All patients showed no graft rejection.  Surgical outcomes were generally good, with minimal or no ocular complications. 16 of 20 patients had excellent results, showing good lid symmetry and esthetics, minimal auricular discomfort, patient satisfaction and proper lid function. Surgical outcomes were highly dependent on proper post-op conjunctiva formation. All patients were positive for CK 19, thus indicating proper conjunctiva tissue formation.

Conclusion: Lower lid reconstruction surgery using auricular chondral-perichondral conchal tissue is a good alternative in patients with neoplastic lesions. Autologous chondral-perichondral tissue provides good functional and mechanical support in the reconstructed lid, thus reducing the risks of ectropion and corneal exposure and ensuring a protected ocular surface.

Indoor Air Pollution and Women’s Health in Rural Areas

Mohd. Yunus Khan, P. Sudhakar Rao

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 10-15

Indoor Air Pollution (IAP) refers to the contamination of air inside and around the building. It is an intense issue on the grounds that indoor air is unquestionably more concentrated with pollutants than open air and can unfavorably influence the inhabitants. Health issues as a consequence to indoor air pollutants might be experienced not long after subjection or after some time. Understanding and controlling probable sources of the indoor air pollution can help decrease danger of indoor health concerns. In this paper, various aspects indoor air pollution, their influence on human health and control strategies has been discussed. Special reference is made to the women’s health in rural areas. Utilization of solid fuels (like wood, dung, coal) for cooking and heating purpose is the significant causation of indoor air pollution in the rural areas, to which women are exposed. Efforts should be made to utilize least polluting fuel for cooking, which can reduce pollution level significantly.

Critical Overview on Primary Lymphoepithelioma-like Carcinoma of the Prostate Gland: A Review of the Literature

Anthony Kodzo-Grey Venyo

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 16-28

Background: Primary lymphoepithelioma-like carcinoma of the prostate gland (PLELCP) is rare with hardly any information on its diagnostic features and biological behaviour.

Aim: To review the literature.

Methods: Various Internet data bases were searched.

Literature Review: PLELCP is extremely rare and there are hardly any pictures of the tumour involving the prostate; hence it would appear that clinicians would need to use their knowledge of the microscopic and immunohistochemical characteristics of the tumour in the nasopharynx and urinary bladder as diagnostic aid. PLELCP on microscopy mimics nasopharyngeal LELC. The LELC component of the tumour is characterized by indistinct cytoplasmic borders and a syncytial growth pattern. The stroma may be densely infiltrated by lymphoid cells admixed with some plasma cells and neutrophils and at times prominent infiltration of eosinophils. PLELCPs tend to have adenocarcinoma, either as the only pattern or with additional ductal components or adenosquamous carcinoma. PLELCPs stain positively with PSA, PSAP, AMACR/P504S, EMA, and cytokeratins AE1/AE3, 7, 8, and 20. There is no consensus on treatment of PLECP. The reported prognosis has been poor.

Conclusions: PLELCPs should be entered into a multicenter trial to determine the biological behaviour and to find the best treatment option that would improve the prognosis.

Brief Overview of Clear Cell Adenocarcinoma of the Urethra: Review of the Literature

Anthony Kodzo-Grey Venyo

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 29-50

Background: Clear cell adenocarcinoma of the urethra (CCAU) is extremely rare and a number of clinicians may be unfamiliar with its diagnosis and biological behaviour.

Aims: To review the literature on CCAU.

Methods: Various internet databases were used.

Results/Literature Review: (i) CCAU occurs in adults and in women in the great majority of cases. (ii) It has a particular association with urethral diverticulum, which has been present in 56% of the patients; is indistinguishable from clear cell adenocarcinoma of the female genital tract but is not associated with endometriosis; and probably does not arise by malignant transformation of nephrogenic adenoma. (iii) It is usually, readily distinguished from nephrogenic adenoma because of greater cytological a-typicality and mitotic activity and does not stain for prostate-specific antigen or prostatic acid phosphatase. (iv) It has been treated by anterior exenteration in women and cysto-prostatectomy in men and at times by radiotherapy; chemotherapy has rarely been given. (v) CCAU is aggressive with low 5-year survival rates. (vi) There is no consensus opinion of treatment options that would improve the prognosis.

Conclusions: Few cases of CCAU have been reported. Urologists, gynecologists, pathologists, and oncologists should report cases of CCAU they encounter and enter them into a multicentric trial to determine the best treatment options that would improve the prognosis.

Extrarenal Retroperitoneal Angiomyolipoma: A Review of the Literature

Anthony Kodzo-Grey Venyo

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 51-76

Background: Extrarenal retroperitoneal angiomyolipomas are rare.

Aim: To review the literature.

Results: Angiomyolipomas, previously classified as hamartomas, are now classified as benign tumours. Thirty cases of primary retroperitoneal angiomyolipomas have been reported. Diagnosis of the disease upon is based radiological and pathological findings of triphasic features of (a) fat and (b) blood vessels and myoid tissue. Immunohistochemistry tends to be positive for HMB45, MART1, HHF35, calponin, NKI-C3, and CD117. The lesion is common in women. Treatment options have included the following: (a) radical surgical excision of the lesion with renal sparing surgery or radical nephrectomy in cases where malignant tumours could not be excluded and (b) selective embolization of the lesion alone or prior to surgical excision. One case of retroperitoneal angiomyolipoma was reported in a patient 15 years after undergoing radical nephrectomy for angiomyolipoma of kidney and two cases of distant metastases of angiomyolipoma have been reported following radical resection of the tumour.

Conclusions: With the report of two cases of metastases ensuing surgical resection of the primary lesions there is need for academic pathologists to debate and review angiomyolipomas to decide whether to reclassify angiomyolipomas as slow-growing malignant tumours or whether the reported cases of metastases were de novo tumours or metastatic lesions.

Brief Overview of Melanoma of the Urinary Bladder: A Review of the Literature

Anthony Kodzo-Grey Venyo

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 77-97

Background: Melanomas of the urinary bladder and urethra are rare.

Aims: To review the literature on the disease.

Methods: Various Internet databases were used to identify reported cases of the disease.

Results: Less than 30 cases of primary melanoma of the urinary bladder and urethra have been reported in the literature and they have been associated with melanosis and commonly with metastases. The lesions may be primary or metastatic with no gender preference. The diagnostic features include pigmented raised lesions which histologically exhibit spindled or epithelioid cells, necrosis, mitotic figures, and atypical melanocytes. Immunohistochemically they stain positively with S100; HMB45; and other melanocyte markers, but negatively with Keratin and Vimentin. The treatment involves excision and possibly IL-2. The prognostic factors include size and depth of invasion as well as metastatic lesions.

Conclusions: Less than 30 cases (about 24 cases) of the disease have been reported. There are also reports of metastatic melanomas of the urinary bladder emanating from primary melanomas originating elsewhere. Diagnosis of the primary disease is based upon the histological appearance of the lesion, positive staining with S100 and HMB45, and evidence of absence of melanoma elsewhere. Primary melanoma of the bladder is usually a fatal lesion.

Role of Cord Blood Ischemia Modified Albumin in Normal Pregnancies and Pre-Eclampsia

Kiran Dahiya, Raunak Ahlawat, Rakesh Dhankhar, Priya Dahiya, Navdeep Hooda

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 98-103

Hypertensive disorders of pregnancy (which include pre-eclampsia) are one of the most common causes of death due to pregnancy. Pre-eclampsia is defined as hypertension (systolic blood pressure>140 mmHg, diastolic blood pressure >90 mmHg) after gestation of 24 weeks along with proteinuria (urine protein concentration >300 mg in 24 h sample. Pre-eclampsia increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia. During acute ischemic conditions, the metal‐binding capacity of albumin to transition metals such as copper, nickel, and cobalt is reduced, leading to the generation of a metabolic variant of the protein, commonly known as ischemia‐modified albumin (IMA). Preeclampsia is characterized by poor placental perfusion due to vasospasm of uterine spiral arteries. It is associated with ischemia and increased oxidative stress, which may lead to modification of plasma albumin to ischemia modified albumin. IMA measurement has recently been proposed as a sensitive marker for the diagnosis of myocardial ischemia but it has been reported to be associated with other conditions also where ischemia is involved. Reports on estimation of cord blood IMA in pre-eclampsia are quite sparse and this chapter aims to analyze the role of IMA in cord blood of pre-eclamptic patients.

Is the Difference in Service Fairness between Private and Public Hospitals Influencing Customer Satisfaction?

Sri Bramantoro Abdinagoro, Mts Arief, Diena Dwidienawati

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 104-114

Indonesia is one of several low-middle income countries aiming to improve its health financing system and implement universal health coverage. The implementation of the program caused the fast increase of healthcare demand. The rapid expansion of insurance coverage, without the development of infrastructure, will create demand that cannot be met by the existing healthcare system. The sudden increase in demand will disrupt the delivery of service, especially in public hospitals, which will influence service satisfaction levels. A preliminary study shows that satisfaction levels of BPJS Kesehatan patients are still low. The most frequent reasons cited for dissatisfaction are fairness issues such as different treatments and different processes and procedures. Studies have found that aside from evaluations of quality, fairness is indeed an important factor that influences satisfaction. Yet there are limited empirical researches on the effect of service fairness on service delivery, especially in the healthcare industry. This study addresses the question of whether there are direct relationships between three variables of fairness and customer satisfaction. In other words, are there different levels of perceived service fairness in private and public hospitals and, if so, does this have an impact on customer satisfaction? Using a descriptive quantitative method, this study was conducted on BPJS Kesehatan members who used 19 public and private hospitals in nine cities in Java, Indonesia. A six-point Likert scale questionnaire was designed and distributed. Four hundred and six samples collected were eligible for analysis using descriptive analysis and structural equation modelling using LISREL. The results show that there is a positive impact of the three variables regarding service fairness on customer satisfaction in public and private hospitals. However, the relationship between distributive fairness and customer satisfaction is not significant in public hospitals. This study strengthens the building evidence that service fairness, in addition to service quality, influences customer satisfaction, specifically in service delivery in the healthcare industry.

Restrictive Cardiomyopathies: Diagnosis and Management

Aidonis Rammos, Aris Bechlioulis, Lampros Lakkas, Aikaterini K. Naka

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 115-143

Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies, it can be idiopathic, familial (autosomal or X-linked, dominant or recessive) or secondary to systematic disorders. Patients commonly present with symptoms and signs of congestive heart failure (HF). Electrocardiographic findings are non-specific and include supraventricular and ventricular arrhythmias, atrioventricular conduction and QRS complex abnormalities. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis, while cardiac computed tomography (CT) and nuclear imaging assist in specific conditions. Echocardiography reveals normal-sized or hypertrophied ventricles, atrial enlargement and preserved systolic and impaired diastolic function, often with restrictive filling pattern. CMR with a higher spatial resolution than echocardiography provides detailed information about anatomy, perfusion, ventricular function and tissue characterization. Also CMR with late gadolinium enhancement (LGE) and myocardial mapping can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. Endomyocardial biopsy may be required if non-invasive studies fail to pose diagnosis. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiophy, is important since both present as HF with preserved ejection fraction but CP can be treated, while the treatment options of RCM depend on the underlying condition. Prognosis is generally poor despite optimal medical treatment.

Post-Transurethral Resection of Prostate Recurrent Life Threatening Hematuria: A Case Report with Review of Literature

Mukesh Chandra Arya, Vivek Vasudeo, Samir Dhingra

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 144-148

Herein, we present a case report of post-TURP (transurethral resection of prostate) recurrent severe hematuria due to right internal iliac artery pseudoaneurysm protruding into bladder lumen. A 60-year-old male presented with recurrent massive hematuria following TURP done elsewhere 15 days before. His hemoglobin was 4gm/dL after 13 units of blood transfusion and repeated clot evacuations. His blood urea, serum creatinine, and coagulation profile studies were normal. Ultrasonography of abdomen showed multiple clots in the bladder. Cystoscopy revealed clots with a right posterolateral wall unhealthy area. After stabilizing the patient, contrast enhanced CT urography revealed intravesical pseudo aneurysm. CT angiography showed pseudo aneurysm of a branch of internal iliac artery protruding into urinary bladder lumen. We referred patient to selective embolization of the lesion but the procedure was unsuccessful. At last, ipsilateral internal iliac artery ligation relieved hematuria. But on postoperative day 2, patient suddenly collapsed and deceased, presumably due to cardiomorbidities.

Medical Students and Type 2 Diabetes Mellitus: Knowledge and Approach

Zulfiqar Khosa, Mukhtar Mehboob, Muhammad Zubair, Hamaiyal Sana, Abdullah Zulfiqar Khosa

Research Trends and Challenges in Medical Science Vol. 1, , 13 June 2020, Page 149-156

Objective: To see the approach of medical students of Bolan University of Medical and Health Sciences Quetta about the knowledge of Type 2 Diabetes Mellitus.

Methodology: This cross sectional descriptive study was carried out on MBBS students of Bolan University of Medical and Health Sciences Quetta Pakistan from 1st May 2017 to 30 June 2017 (two months). The sample size was 200 students. The questionnaire included 12 questions about diabetes mellitus, related to general knowledge of Type 2 diabetes mellitus. The students were divided into two groups. The group I was the students who think that they have knowledge of type 2 diabetes mellitus and the group II was the students who think that they have poor or deficient knowledge of type 2 diabetes mellitus. Each question was allocated 5 marks. After giving marks to all replied questions, the total 60 marks for 12 questions were further categorized as; A score of less than 20 poor, 21-30 average, 31-40 good, ˃ 40 excellent. The results were analyzed by SPSS.

Results: There were 174 (87.0%) students who had some knowledge of type 2 diabetes mellitus, while 26 (13.0%) had no any knowledge of diabetes mellitus. The students having age of 20 years or more were 126 (63%) where majority 107 (53.5%) were studying in second year. There were 102 (51%) male and 98 (49%) female students. The knowledge of investigation and diagnostic criteria for type 2 diabetes mellitus were found significant amongst all. The knowledge of etiology, symptoms, course, treatment and complications were found insignificant. Only 10 (5%) students had excellent knowledge of type 2 diabetes mellitus.

Conclusion: The students having an age of more than 20 years had excellent and more knowledge of type 2 diabetes mellitus. The problems of diabetes mellitus among relatives of students and friends, its causative factors, symptoms and course was found insignificant. The knowledge of diagnostic test and interpretation had a positive correlation but insignificant. Majority of students 96 (48%) had average knowledge of diabetes mellitus.